Skin bends/cutaneous DCS (imgs).

[gert7to3]

Very helpful and informative photos DocVikingo. Also very tragic. Both divers needlessly injured themselves with such careless dive profiles.

 

[3D diver]

Ok...I'm a hypochondriac...show me a symptom and I start thinking...

Both images are fairly similar in appearance. Is there much variation in presentation? Does it respond at all to things like antihistamines or cortisone creams? Wouldn't want to confuse an allergic reaction with something more serious, or vice-versa.

Thanks

 

[DocVikingo]

Is there much variation in presentation? Does it respond at all to things like antihistamines or cortisone creams?

Hi 3D diver,

Cutaneous DCS usually presents as a constant & intense itching that might make one think of an allergic reaction. And, it may improve with an oral antihistamine or a topical antihistamine or steroid preparation. However, cutaneous DCS very likely will respond even better to the prompt & proper administration of 100% O2, which an allergic reaction will not do.

Cutaneous DCS typically affects areas of the body rich in fatty tissue. The torso (especially the stomach area), shoulders & arms often are involved. The condition may be associated with a reddish rash or a mottled/marbled rash (cutis marmorata; shown in the images provided above). The rash tends to clear within an hour or two, and almost always within 24 hours. An allergic reaction can of course appear anywhere on the body, including areas where cutaneous DCS is almost never seen (e.g., hands & feet). And healing time, while variable, is usually longer than a couple of hours and can in some instances be relatively long-lasting, e.g., cnidarian envenomations.

As for presentation, if so inclined one can break down cutaneous DCS into a variety of subcategories. For example, 40+ years ago the U.S. Naval Submarine Medical Center suggested six types (See pages 1-2) --> http://www.dtic.mil/dtic/tr/fulltext/u2/749317.pdf. It is my impression that this fine-grained nosology never really gained much ground in the diving medicine/hyperbaric medicine community, but it may prove useful in orienting the lay diver to possible manifestations and levels of concern in the presentation of cutaneous DCS.

Bottom line is, if in doubt it is prudent to get on 100% O2 and have it checked out by a diving medicine specialist. An isolated incident of cutaneous DCS as a sole symptom of DCI, especially if mild, usually is nothing more than a transient & harmless bother. However, some cases are associated with potentially worrisome symptoms that aren't always initially easily observed, and even with PFO.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.